Transvaginal Laparoscopically-Assisted Endoscopic Appendectomy: A Major Hybrid Natural Orifice Transluminal Endoscopic Surgery Case Series in Asia

Abstract

Hybrid NOTES procedures can be performed safely using a solo-umbilical trocar. Our initial experience reveals that this hybrid technique is practically feasible and associated with minimal post-operative pain, reasonable convalescence time, and improved cosmetic outcomes.

Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study

“…Because it does not result in surgical scar, NOTES has been receiving substantial attention from surgeons in many countries. NOTES was used not only for hysterectomy but also for adnexectomies [ 6 7 8 9 ], ectopic pregnancies [ 10 11 ], appendectomies [ 12 13 14 15 ], and cholecystectomies [ 16 17 18 ]. Recently, feasibility and technique for transvaginal NOTES liver resection was studied in a porcine model [ 19 ].…”

Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology

“…Steinemann et al also stated that hybrid NOTES reduces postoperative pain and is associated with greater cosmetic satisfaction [ 17 ]. Khan et al revealed that hybrid V-NOTES appendectomy is associated with minimal post-operative pain, shorter healing time, and improved cosmetic outcomes [ 18 ].…”

Transvaginal laparoscopic appendectomy using innovative submucosal tunnels: a conducive modification for improving hybrid NOTES access and its critical appraisal

“…Natural orifice transluminal endoscopic surgery (NOTES) has been predicted to replace conventional laparoscopy in the near future. [1][2][3][4][5][6][7][8][9][10] In addition, the transvaginal route, having typical physical and physiological benefits, [1][2][3][4][5][6][11][12][13][14][15][16] makes it the safest, as well as an immensely popular method. [1][2][3]6,[11][12][13][14][15][17][18][19][20][21][22][23][24][25][26] However, even a decade after its inception, it continues to be fraught with diverse technical hurdles such as spatial constraints, inadvertent vaginal gas-leak, compelling requirements for complex instrumentation, scarce availability and affordability, and a steep learning curve, to name a few.…”

“…[1][2][3]6,[11][12][13][14][15][17][18][19][20][21][22][23][24][25][26] However, even a decade after its inception, it continues to be fraught with diverse technical hurdles such as spatial constraints, inadvertent vaginal gas-leak, compelling requirements for complex instrumentation, scarce availability and affordability, and a steep learning curve, to name a few. 7,[13][14][15][16][17][18][19][20] Gas leaks from the vaginal port-rents fail to maintain adequate pneumoperitoneum and often necessitates tamponade by wet compresses. This hinders a smooth performance, leading to extended surgical times.…”

“…13,27 Access-related difficulties have virtually halted the progress and expansion of NOTES into the surgical fraternity, as well as patient community. 1,15,19 Technical improvisations have multiplied, 2,7,14,18,27,28 but published techniques are not only obtuse but require more expensive gadgets and multidisciplinary engagements. 3,6,10,15 In this context, we present a novel transvaginal access during hybrid NOTES by carefully designed submucosal tunnels and share our initial experience of appendicectomy using this method.…”